Oliver and the Tiny Intruder
What It’s Like To Be Retired

Medicare and Hospital Errors

category_bug_journal2.gif Beginning 1 October 2008, Medicare will no longer pay hospitals for treating preventable errors. The new ruling lists eight specific conditions for which payment will be withheld:

  • Retrieval of surgical tools or sponges left in a patient
  • Surgical site infection after coronary artery bypass surgery
  • Injuries caused by falls in hospitals
  • Infections caused by prolonged use of catheters n the bladder or blood vessels
  • Treatment for bedsores developed in hospital
  • Extra care for patients harmed by incompatible blood/li>
  • Extra care for patients harmed by air embolisms

The hope is that this change will encourage hospitals to pay more attention to common-sense precautions to prevent these conditions. The Centers for Disease Controls and Prevention estimates

“…that patients develop 1.7 million infections in hospitals each year, and it says those infections cause or contribute to the death of 99,000 people a year – about 270 a day.”
The New York Times, 19 August 2007

Wall Street analysts are not so sure that loss of income, estimated at about $20 million per year spread over just under 5,000 hospitals in the U.S., is incentive enough for hospitals to reduce errors.

“Medicare pays hospitals over $100 billion a year, so $20 million is less than 0.02%,” [says Bear Stearns analyst Jason] Gurda…”I’m not expecting a significant impact although it is a first step toward paying for quality.”
CNNmoney.com, 17 August 2007

According to Investor’s Business Daily reprinted at cnnmoney.com, private insurers follow Medicare’s lead and they may also stop paying for treatment for hospital medical errors.

Hospitals are concerned that they will need to absorb the costs of additional tests to determine what infections or conditions are present when a patient is admitted. Fortunately, the new Medicare ruling disallows “shifting costs of preventable errors to patients or their insurers”, according to The New York Times.

Overall, this appears to be a good move to light a fire under hospital workers to improve what most of us would consider basic hygiene practices. A three-year-old study published in the Annals of Internal Medicine reports:

“Doctors cleansed their hands 57% of the times that they should have. They cleansed hands most often when a hand-rub solution was easily available.

“They did not wash hands as often when they had busy workloads with many patient interactions and when they performed activities with high risks for spreading infections. These activities required cleansing hands immediately before examining patients or between examining different body sites on the same patient.

“Medical students and internists (internal medicine doctors) washed hands most often, whereas anesthesiologists, critical care physicians, and surgeons washed hands least often. Doctors who valued hand hygiene and considered themselves role models washed hands often.”

[At The Elder Storytelling Place today, Celia Jones explains how well experience applies - or not - in Old Hands at Minding New Granddaughter.]


In the UK, poor infection control is allegedly a problem too, but often the US is held up as an exemplar. I don't know why, since you spend much more per head as a nation on health care than we do, still seem to leave huge numbers outside the system and now it seems are no better at controlling infection either.

On a related topic I recall a study here in the UK that took swabs from doctor's ties - not good...

I wonder if the unintended consequence of this practical solution will be higher hospital bills. However, something must be done to improve efficiency and cleanliness.

As patients, we should all demand that our health care practitioners wash their hands before touching us. I hope Medicare will also stop paying doctors that remove the wrong leg/eye/kidney/etc. and see that they also lose their medical license.

Sigh. Just another way to mess with people who can ill afford it. Why doesn't any of this surprise me?

From the time I was a child I have been horrified at people's poor hand washing habits.

I used to watch very carefully at the pediatrician's office and was appalled at my own mini study over the hygiene of medical professionals.

The thing is, you cannot tell if someone has just washed their hands or not, so patients just assume that they have.

I have always thought that the physician should wash their hands in front of you before an exam. Some do. Most do not.

Does it seem strange to anyone that the cruise ship lines are more careful about hand sanitation than our hospitals are?

I was recently on Royal Caribbean and every time you entered or left the dining room you had to use a hand cleanser that was in a very convenient dispenser. It only took a second for you to place your hand under a ball of cleanser and the right amount would drop into your hand. No drying was necessary.

My husband was recently in the hospital and no such hand cleansing device was provided to staff or visitors.

Maybe the medical profession should take a tip from the Cruise Lines.

I saw a documentary on this recently. The same problems here in Canada. Undercover cameras caught nurses and doctors don't wash their hands or wear protective gear even when treating patients labelled as highly contagious and dangerous. However, infection control awareness does seem to be on the rise due to recent scares of superbugs.

But the problem, I think, is because of under staffing. With nurses and doctors working long long shifts, people become overly stressed. I hope our hospitals hire enough staff so hospitals can focus on raising their quality standard.

the real question though is whether it will lead hospitals to improve their care or just leave the ordinary citizen paying to get healthy after someone else's mistake :(

Seems to me that the patient will be the one to suffer, because he will probably have to pay for what Medicare won't pay. Could this just be another excuse to keep Medicare from having to cough up the money for treatment?

I would assume that the withholding of Medicare payments will simply create another incentive for hospitals to pretend the various errors didn't take place. Watch these things mostly simply get coded differently -- and occasionally simply allowed to kill a money-losing patient.

The reported statistics will then look better. Whoopee!

This Medicare goal is noble, but will likely not result in the expected and desired response, IMHO.

This will mean additional costs for hospitals and they'll just up the costs they bill patients -- yeah, janinsanfran, those magic codes and the language terms used to describe medical problems.

Any expectation that quality of service will be improved by adding staff in this day of tightening health care costs is a pipe dream. If anything, there will be even more staff cutbacks. No wonder nurses and staffs have unionized in some hospitals to try and prevent being worked to death.

One more thought of many, from when I first heard this Medicare announcement. Injuries by falls, and bedsore treatment are of special concern. Many falls occur because no one can sit with the patient 24/7. Fragile skin breakdown into bedsores also requires a level of time and care necessitating increased staffing.

Will skilled nursing facilities (SNFs) no longer be willing to accept patients at high risk for, or with these problems which they're expected to heal? What about the nursing shortage?

I visited someone in a hospital yesterday that did not allow smoking on site at all. So, the smoking medical caregivers were across from the hospital on an island siting on cement steps, leaning against trees, etc. - dressed in lab coats, scrubbs (footies included)and various other hospital garb. Now, just imagine what germs they bring back to the patients.

The fact that these doctors and hospitals try to hide their mistakes just sickens me. Hopefully they'll change the laws soon to protect innocent people from going through this!

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